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12020001
CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 5938 SUTTON PARK PL OWNER'S NAME: ROBERTS JAMES A AND JANET OWNER'S PHONE: 4082579980 LICENSED CONTRAC(T�O2R'/S DECLARATION License Class rl 617 Lie. # ZS l b o L Contractor Date I hereby affirm that m lic . ed under the provisions of Chapter 9 (comrmencing w' S 1 7000) of Division 3 of the Business & Professions Code and that v icense is in full force and effect. I hereby affirttr under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Si2nat Date 2 I © ONV ER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor`s License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Protessions Code). CONTRACTOR: THD AT-HOME SERVICES,I PERMIT NO: 12020001 INC. 2690 CUMBERLAND PKWY STE 300 DATE ISSUED: 02!01%2012 ATLANTA, GA 30339-3913 PHONE NO: (sto) 7tI-to©a r-- — F– BUILDING PERNIIT INFO: BLDG ELECT PLUNIB MECH ' RESIDENTIAL CONIMERCIAL JOB DESCRIPTION: INSTALL TWO(2)WINDOWS AND TWO(2)PATIO DOORS;NON-STRUCTU RA L I hereby affirm under penalty of perjury one of the following three declarations: I have anis will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of Cite work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicartt understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.13. Signature Date Sq. Ft Floor Area: I Valuation: $5571 APN Number: 37535031.00 1 Occupancy Type: PERMIT EXPIRES IF FORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or au ager : Date: Z ) Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO 5P_ IRIFF FqTIMATOR - RITILDING DIVISION i LAADDRESS: 5938 sultan park place. DATE: 02/01/2012 REVIEWED BY: bobs. APN: I BP#: VALUATION: 1$5,571 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Window Sliding Glass Door 11VINREP Replacement PENTAMATION 1GENRES I PERMIT TYPE: WORK install 2 windows and 2 patio doors non structural. h rs, SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Pumic works, Pire, aanizary newer "isirict, acnovi L_ A #L ""d oro n"hy an octimayo Cnntart thp Dow fnraddnl info. FEE ITEMS lk s„-Vyh-'�m J h1i. , ' 111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 4 j# $392.001 Window Sliding Glass Door 11VINREP Replacement Suppt. PC Fee: (j) Reg. 0 OT ILI h rs, $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 SUPPI. Insp. Fee. -G Reg. 0 OTFO-071 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 0 Work Without Permit? 0 Yes (D No $0.00 PhffnlillFecl� $0.00 Select a Non -Residential Building or Structure 0 Fc -e: IBSELSHICR $0.56 Select an Administrative Item B I d”, g S Coli T r... i s s Jc? n F e: IBCBSC $1.00 SUBTOTALS: $1.56, $392.00 TOTAL FEE: $393.56 Revised: 1/19/2012 3 ITEMS OF 3 CITY.OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37535031.00 DATE ISSUED.......: 02/01/2012 RECEIPT #......... BS000015893 REFERENCE ID # ...: 12020001 SITE ADDRESS 5938 SUTTON PARK PL SUBDIVISION CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ROBERTS JAMES A AND JANET ADDRESS 5938 SUTTON PL CITY/STATE,/ZIP ...: CUPERTINO, CA 95014-3531 RECEIVED FROM ....: JEFF RAINEY CONTRACTOR .......: FRANCES BLAKE LTC # 29818 COMPANY ..........: THD AT-HOME SERVICES, INC. ADDRESS ..........: 2690 CUMBERLAND PKWY STE 300 CITY/STATE/ZIP ...: ATLANTA, GA 30339-3913 TELEPHONE ........: (510) 731-1004 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ------- THIS REC NEW BAL __________ _____________ 1BCBSC VALUATION ---------- 5,571.00 ---------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 5,571.00 0.56 0.00 0.56 0.00 1WINREP EACH 8 4.00 392.00 ---------- 0.00 392.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 393.56 0.00 393.56 0.00 METHOD OF PAYMENT AMOUNT REFERENCE ---------- NUMBER ----------------- --------------- CREDIT CARD 393.56 MC --------------- TOTAL RECEIPT 393.56 LL9t76 VO `Oapueal ueS14056 dO `ONm:jJ mnoLn •10 euaan 99vz H "-ld N1 Nd NOl1nS 9E69 " z MJON) SWINGS GWOH Ib - GHl S12:E]80�1 IDW �j W W ID I- Z J � m w wzm Sao w F o D- 0 z D- z Zp� N cl z �d 6 O LU F- ZX Q O (` M ✓y o !'j X Fav `'O CN ' cd 3 2 c,�- r g, � o -o µ � o ((P. c5 , 3 O Ggo 9 �0 7� — �, L6 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 79'3 507-ro.j n Acc PERMIT # C✓0 OWNER'S NAME: PHONE # qiPg, 7-5 0 GENERAL CONTRACTOR: ` F t'*i e BUSINESS LICENSE # ADDRESS: Z+-, (o CITY/ZIPCODE: 5 AJ L -C-4 ✓DR -0 74 -7 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRAC' ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: �— 1 �- Si re Date Please check applicable subcontractors complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner /or Signature 4 / ► Z - Date ac)a 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 its (408) 777-3228 • FAX (408) 777-3333 • building cupertino.orq CUPERT1f40 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI r❑ REVISION /DEFERRED ORI/GGIINALL PERMIT # S 3 5U T"T�/� ?1 1_ C APN# PROJECT ADDRESS A< /� PHONE �7 E-MAIL OWNERNAME �� [ U 1 C q -T C F J CITY, STATE, ZIP l FAX STREET ADDRESS n 2 77.E �L _ �/ �J�i �� • �� I PHONE E-MAIL CONTACT NAME ( i + to . j. Z 6 Q STREET ADDRESS ^j l CITY, STATE, ZIP FAX04 El OWNER ❑ OWNER -BUILDER El OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHIT'ECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT ICITY, ER LICENSE TYPE BUS. LIC # CONTRACTOR NAME 836021 B, C3 9, C 13 , C 17 FAX COMPANY NAME S10-783-1041 THD @ HOME SERVICES ATE, ZIP PHONE STREET ADDRESS EANDRO,CA 94577 510-877-4550 2456 VERNA STREET ARCHITECT/ENGINEER NAME 7777ILL COMPANY NAME STREET ADDRESS f DESCRIPTION OF WORK f�-��TL� I K nJ r� C C F A.J EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES D ""' ON .Fr. VALUATION O� TYPE EXISTG NEW FLOOR DEMO TOTAL /i .1 �SY 7 / AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: ❑ DETACH ❑ ATTACH # DWELLING UNUS: SECOND UNIT ❑ YES SECONDSTORY ❑ YES �IS NG ADDED? ❑ NO ADDITION? ❑ NO ❑ YES ES.PROVIDECOPYON PLANNER'SNAME: RECEIVED BY: / ALUATK)N,-JPRE-APPLICATION 4�r[ PLANNING APPL # ❑ NO PLANNING APPROVAL LfTCER authorized agent to act on the property owner's behalf. I have read this By my signature below, I certify to each of the following: I am the property owner or Description of Work and verify it is accurate. I agree to comply with all applicable local application and the information I have provided is correct. I have read the of Cupertino to enter the above-identifieden property for inspection purposes. ordinances and state laws relating to building construction. I authorize representatives / Date: Signature of ApplicanUAgent SUPPLEMENTAL INFORM ED PLAN CHWKTYPE ROUTING SLIP SFD Multifamily dwellings:`pply for demolition permit for ❑ OVrR_THE_COUNTER ❑ BUILDING PLAN REVIEW New or existing building(s). Demolition permit is required prior to issuance of building ❑ EXPRESS ❑ PLANNING PLAN REVIEW permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS _ forth if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWERDISTRICT _ submittal of Building Permit application. ❑ ENVIRONMEPITALHEALTH BldgApp_2011.doc revised 03/16/11